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News & Opinion

  • News:

    May 2018

    Scientist,Dr David Goodall, at the great age of 104, who suffered no serious illness, but was tired of living with ‘reduced abilities’, travelled to Switzerland to end his life as he desired.David Goodall

    http://www.bbc.co.uk/news/topics/cljev4r3zgxt/euthanasia-and-assisted-dying

  •  Guernsey to debate Assisted Suicide, May 2018: possible implications  for the UK?

    Teresa Lynch

  • The Catholic Church’s teaching

 

  • Pope Pius XII, who witnessed and condemned the eugenics and euthanasia programs of the Nazis, was the first to explicate clearly this moral problem and provide guidance. In 1980, the Sacred Congregation for the Doctrine of the Faith released its Declaration on Euthanasia which further clarified this guidance especially in the light of the increasing complexity of life-support systems and the promotion of euthanasia as a valid means of ending life. The new Catechism (No. 2276-2279) provides a succinct explanation of our Catholic teaching on this subject.Before addressing the issue of euthanasia, we must first remember that the Catholic Church holds as sacred, both the dignity of each individual person and the gift of life. Therefore, the following principles are morally binding: First, to make an attempt on the life of, or to kill an innocent person, is an evil action. Second, each person is bound to lead his life in accord with God’s plan and with an openness to His will, looking to life’s fulfillment in heaven. Finally, intentionally committing suicide is a murder of oneself and considered a rejection of God’s plan. For these reasons, the Second Vatican Council condemned “all offenses against life itself, such as murder, genocide, abortion, euthanasia and willful suicide” (Gaudium et Spes, No. 27).

 

  • Reasons for requests for assisted suicideRequests for assisted death usually arise from a person who is depressed, or whose symptoms are not controlled, and/or are fearful of what is before them, like abandonment or increasingly – a fear of being a burden.  No one should overlook the findings of audits in countries and states where Assisted Suicide is legal that, ‘fear of being a burden’ underlies many people’s request for assisted suicide, rather than pain.  Many of these patients have never been assessed by a psychiatrist for treatable, clinical depression. 

    The Nursing Code of Conduct

    The Nursing and Midwifery Council (NMC), in their Care Booklet, stress that nurses must promote dignity and self-worth. This involves showing empathy and encouragement. For patients or their relatives to feel that the patient would be better off dead, does not promote self-worth and many will equate dignity with death and killing will become an option.

    The Nursing and Midwifery Council’s Code of professional Conduct (2015), states that nurses must make the care of the patient their first concern. If symptoms are present but are not being not relieved and fears not addressed, by referrals to the appropriate members of the Multidisciplinary team for their specific expertise, nurses are not meeting the holistic needs of the patient.

     

     

    Palliative and Holistic Care

    The Hospice movement was created to provide palliative care for any patient. It is  an active and total approach to care, from the point of diagnosis and prognosis, throughout the person’s life, death and beyond. It embraces physical, psychological, emotional, social and spiritual elements and focuses on the enhancement of quality of life for the person and support for the whole family. It includes the management of distressing symptoms, provision of short breaks, care at the end of life and bereavement support. This requires the involvement of all relevant members of the multidisciplinary team.

    Caring for any patient requires holistic assessment of their care needs and the planning, implementation and regular evaluation of that care. This is particularly important for elderly patients who are described as healthcare’s ‘core business’.

    There is growing interest in holism which emphasizes that all three aspects of the person: psyche, soma and spirit must be addressed. The Nurse’s Code of Conduct (NMC 2015), expects nurses to make sure that people’s physical, social and psychological needs are assessed and responded to in the following ways:

    • pay special attention to promoting well- being, preventing ill health and meeting the changing health and care needs of people during all life stages
    • recognise and respond compassionately to the needs of those who are in the last few days and hours of life
    • act in partnership with those receiving care, helping them to access relevant health and social care, information and support when they need it.

    In the practical circumstances, however, in which staff caring for patients feel under pressure, and experience themselves as having very little time, it is often difficult to  provide one thing – time, for the patient, that makes him or her feel cared for.

    Safeguards and ‘the slippery slope’

     

    The evidence in countries where assisted suicide is legalised, is that there is erosion to the point of destruction of effective Palliative Care and terrible abuse of the law.

     

    Moreover, existing extensions of the law in some countries for non- physical or psychological reasons for requesting death is a damning indictment of a society which views death as a commodity and consumer right and where ‘safeguards’ become merely obstacles to be overcome.

    Thousands of elderly people in Belgium have been killed by their doctors under the country’s euthanasia law, despite them not giving permission, a new report claims.

    The study published by the Journal of Medical Ethics said that many pensioners are being euthanized by their GPs in Belgium, even though they had never expressed a desire to die unnaturally.   “The Belgian population should be aware of the present situation and know that if their lives may come to the point where physicians think they are not worth living, in the absence of specific living wills advising physicians what to do then, they might be put to death,” said report author Raphael Cohen-Almagor of Hull University. The report claimed that around one in sixty deaths that happened under GP care, involved someone who had never requested euthanasia. Research also showed more than half of the patients killed without giving their consent were over the age of eighty, while two thirds of them were in hospital but not suffering from terminal illness.

    Christian charity CARE said the report was an example of why assisted dying (suicide) was a dangerous precedent. It said the findings were a “serious warning of the consequences of following the same path as countries like Belgium”.  CEO Nola Leach said: “I hope MPs pay close attention to this stark and very serious report, the contents of which is frightening and disturbing – “It is clear a real culture of euthanasia has developed in Belgium in the thirteen years since assisted suicide was legalised”.

    The doctor’s supposed role in this proposal for a change in the law, would inevitably be devolved to nurses as have so many other roles been delegated to nurses over time.

     

    Nurses are trained to provide truly compassionate and dignified care. This means holistic, compassionate care delivered by nurses trained to promote life and its quality, rather than to become agents of the state by agreeing to participate in assisted suicide for their patients.

     

    Parliament’s duty to protect the vulnerable

     

    We must not be afraid to argue that there is nothing compassionate about putting the vulnerable at risk. This is a matter of public safety, and we must not allow it to be spun otherwise. As Baroness Campbell said in her excellent contribution to the Falconer Bill debate “This is a dangerous time to consider facilitating assistance with suicide for those who most need our help and support. It is not only dangerous for those who may see suicide as their only option, but can be tempting for those who would benefit from their absence.”

     

    Parliamentarians themselves need to stick to the public safety angle. Some may agree in principle that we should permit others to help people to die, but there is no way around the argument that allowing the practice would put vulnerable people at risk as Belgium, Holland and Oregon have shown. Parliament and Government have a duty to protect the vulnerable, not put them in jeopardy.

     

    We must be resolute in the face of insults and jeering from those want to see our society taken back to a genuinely retrograde civil society where a ‘winner takes all’ culture, defines the way we see the vulnerable.

     

    Hard cases make bad laws. Any change in the current law would give free rein to eugenics, and economically-driven or defeatist health professionals and others who would act with impunity   Even in a free, democratic society there are limits to human freedom and the law must not be changed to accommodate the wishes of a small number of sadly desperate and determined people, who wish to impose their goals on all.

     

     

    Conclusion

     

    Hard cases make for bad laws Any change in the current law would give free rein to eugenics and economically-driven or defeatist health professionals and others, who could act with impunity.

     

    Opposition to liberalising the law on assisted suicide is due to the risk such changes would pose to public safety and especially the most vulnerable in society.

     

     

    The following links are excellent sources of information:

     

             Catholic teaching:  http://bit.ly/1m36Scv

             The think-tank: Living and Dying Well:   www.livinganddyingwell.org.uk

                  USA  Doctors fear of opioid addiction:  http://www.lifenews.com/2018/05/04/doctors-prescribing-opioids-

                 for-pain- under-attack-docs-prescribing-for-assisted-suicide-given-a-pass/

 

  •  Pope Francis speaks on end of life issues. (Acknowledgement to BioEdge)“Care” vs “overzealous treatment”: Pope Francis has advised doctors to avoid “overzealous treatment” of patients at the end of life, saying that “burdensome” treatment may not be in the bests interests of the person.The term ‘treatment’ however, needs careful consideration and understanding of how it is defined under UK law. Within the UK Mental Capacity Act (2005) the term ‘treatment’ is defined as: any diagnostic or other procedure’ This is an extraordinarily wide definition in relation to true care of patients.Addressing the World Medical Association European Regional Meeting on End of Life Questions — a conference jointly organised by the World Medical Association, the German Medical Association and the Pontifical Academy of Life — the Roman Pontiff said that the development of powerful medical technologies calls for prudent discretion on the part of clinicians.”Within democratic societies, these sensitive issues must be addressed calmly, seriously and thoughtfully, in a way open to finding, to the extent possible, agreed solutions, also on the legal level. On the one hand, there is a need to take into account differing world views, ethical convictions and religious affiliations, in a climate of openness and dialogue.On the other hand, the state cannot renounce its duty to protect all those involved, defending the fundamental equality whereby everyone is recognized under law as a human being living with others in society. Particular attention must be paid to the most vulnerable, who need help in defending their own interests. If this core of values essential to coexistence is weakened, the possibility of agreeing on that recognition of the other which is the condition for all dialogue and the very life of society will also be lost. Legislation on health care also needs this broad vision and a comprehensive view of what most effectively promotes the common good in each concrete situation”.

    https://www.bioedge.org/bioethics/care-vs-overzealous-treatment-pope-francis-speaks-on-end-of-life-issues/12532

  • The role of the Nurse today in a secular age – Teresa Lynch
  • Nursing has traditionally been considered as a vocational profession, with the public’s perception of nurses as ministering angels at the bedside.  Patients warrant high standards of quality care, support and empathy, and rely on the nursing profession to meet this expectation.The word ‘patient’ comes from the Latin: ‘patiens’, meaning to endure, bear, or suffer, and refers to an acquired vulnerability and dependency which is imposed by changing health circumstances. Nurses of a religious belief or none, generally enter the profession with a compelling drive to help others in need. A ‘vocation’ is from the Latin dictionary: ‘to be called – to be summoned’. Nurses are called to a privileged practice. The Anglo-Saxon interpretation of the word ‘care’ was ‘to make extra efforts for someone in need’.Nursing encompasses many different roles, including the important, fundamental role of nurturer. The Latin word for Nurse is ‘nutricula’. This word logically reflects the expectation of the nurse to provide the basic requirements for maintaining a helpless person’s health and life.  Statute law in the UK now defines assisted food and fluid as medical treatment. The nurse is in a good position, in another expected role as  patient’s advocate, to promote the needs of patients for this basic care need:For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink” (Matthew 25:35).Patient advocacy The Lord says, I love justice and I hate oppression and crime’ (Isaiah 61:8).Jesus spent his short life ministering to those without power, advantage or rights.The nurses’ regulatory body, the Nursing and Midwifery Council expects the nurse to act as the patient’s advocate in line with the Nursing Code of Conduct: professional standards of practice and behaviour. The Code is clear: “you will act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care” (NMC 2015). The Code of Conduct can act as a protection for nurses and their patients. It has been argued, however, that the concept of patient advocacy is not a slogan nor a hobby, nor is it to be attempted by the faint-hearted. Why might this role be difficult?

    As Catholics, the Church asks us to monitor our lives and to give up easy options if they stand in the way of achieving some spiritual good. The problems for the nurse, wishing to fulfil the role of the patient’s advocate, may include:

    • an age of secularism, where patient autonomy may be seen as the ultimate arbiter of care (though an important concept, patients do not always understand the complexity of true care and appropriate treatment)
    • healthcare settings are considered as ‘a market place’ and
    • an expectation of compliance with such a prevailing culture.

    Nurses may feel that they are sometimes a lone voice, seeking to promote the best interests of the patient, not wishing to become ‘agents of the state’.

    Those who may consider as defensible, uncaring actions directed at people, due to their vulnerability, lack of economic viability, or even a perceived lack of humanity, are either wittingly or unwittingly acting against their conscience – the voice of God. Oppressing and disregarding the ‘least among us’, requires a response strategy for the strengthening and affirming of conscience. St Teresa of Avila, helpfully reminds us that for His work to be continued, Jesus relies on us to be His hands and feet.

    Any nurse placed in a difficult, clinical situation, where teamwork is considered vital in healthcare, wishing to represent the best interests of the patient, can take heart from the words of Jesus: “Whatever you did to the least of these, you did to Me’ and whatever you neglected to do for the least of these, you neglected to do it for Me” (Matthew 25: 31-46).

     Empathy

    ‘The good nurse’ has been described as someone who does the right thing. For this, nurses need a sensitive conscience. It is argued that many of those who enter the health professions are people of great sensitivity, a characteristic desirable for delivery of empathic care. Empathy has long been seen to be an essential feature of the nurse-patient relationship.

    The philosopher, Edith Stein, (St Teresa Benedicta of the Cross) considered empathy is an irreducible intentional state in which both other persons and the mental states of other persons are given to us. In an empathetic experience, we are presented with not mere bodies in motion, but rather with persons – and they are presented to us as persons who are angry, or who are grieving, or who are filled with joy.

    Nurse Education

    The Nursing Code of Conduct (NMC 2015) contains a series of statements that taken together, signify what good nursing and midwifery practice looks like. Such practice puts the interests of patients and service users first, is safe and effective, and promotes trust through professionalism. 

    Educating nurses on an ongoing basis, about professional values and standards is essential, irrespective of the current degree level entry requirement.  Nursing requires skill at various levels. Before nursing competence is assured, skill needs definition. Any skills, but particularly those required for nursing, comprise knowledge, effective attitude and behaviour.  Competence in caring for patients means consistency of skilled effort and outcome.

    Holistic care

    Caring for any patient requires holistic assessment of their care needs and the planning, implementation and regular evaluation of that care. This is particularly important for elderly patients who are described as healthcare’s ‘core business’.

    There is growing interest in holism which emphasizes that all three aspects of the person: psyche, soma and spirit must be addressed. The Nurse’s Code of Conduct expects nurses to make sure that people’s physical, social and psychological needs are assessed and responded to in the following ways:

    • pay special attention to promoting wellbeing, preventing ill health and meeting the changing health and care needs of people during all life stages
    • recognise and respond compassionately to the needs of those who are in the last few days and hours of life
    • act in partnership with those receiving care, helping them to access relevant health and social care, information and support when they need it.

    In the practical circumstances, however, in which staff caring for patients feel under pressure, and experience themselves as having very little time, it is often difficult to do just that one thing for the patient that makes him or her feel cared for.

    Enabling Compassion

    Training that emphasises professional detachment and regards compassion as non-quantifiable may have a detrimental impact later, on the interpersonal relationships between staff and patients – and to the quality of care delivered. But even where the value of compassion is taught in the syllabus, there is a concern that, without role-modelling and overt endorsement and support for striving to be compassionate towards every patient, every time, it will be eroded and more difficult to practise.

    Enabling staff to feel and always be compassionate towards patients in their care, requires action on multiple levels.

    • At the level of the individual, one of the most powerful resources that nurses consistently cite is patients’ stories.
    • In cases where professionals themselves, or their loved ones, become patients, the nature of their personal experience of care very often has a profound effect on how they carry out their clinical practice.
    • Where first-hand experiences of care are not available, exercises in which staff are asked to role-play or write a narrative, imagining themselves as patients can have a similar usefulness.

    Care of the Dying patient

    Nurses can assist dying people and their families by incorporating the physiological, psychosocial, spiritual, and cultural aspects of dying into the care they provide.  Acting as guides, they can help the dying person and family members through this final life transition with the other relevant members of the Multidisciplinary team, including the minister of religion.

    If we only see death as a medical failure, then we fail to understand that the real gift of medicine and nursing is not just a science but a wisdom: how to live life of which dying is a part. That requires a sense of the wholeness of the person and the wholeness of a life. When it understands this, genuine care will have time for the multifaceted reality of dying. Giving time is the most precious resource of all.

    In the situation when we know how limited the time left is, we need the courage and the generosity of spirit to be most free with it.

    Staff Support

    Clinical supervision which is commonly offered to nurses today, can provide practitioners with a forum for open and honest dialogue about their experiences of delivering care.  A psychologically-safe environment is essential in which to discuss the everyday challenges, frustrations and pressures of the job – in which stories and feelings about patients and their care are shared and validated.

    In the Bible, to be called, means someone is special, privileged to play a particular

    role in God’s plan for his people. God has considered a role for each of us.  We may feel in relation to a possible career in nursing, why me? – with the implication that someone else could do a better job than myself.   That is not the point, God may want us and not others to do the job that only He knows how well we can do for Him, with his continuing help.

     August 2017: What do we mean by ‘Dignity’. See Tiffany Dawson’s excellent ‘abundant life’ blog on this concept from CareNet website: https://www.care-net.org/abundant-life-blog/debunking-the-death-with-dignity-myth?

  • UK  – October 2017. Former lecturer with Motor Neurone Disease, Noel Conway, fails in his bid to be helped to commit suicide but intends to appeal the ruling.

  • His case was supported by Humanists UK and opposed by the secretary of state for justice, Care Not Killing and Not Dead Yet UK, also made submissions.The British Medical Association has previously expressed its opposition to physician-assisted dying, saying it risked putting “vulnerable people at risk of harm” and would be “contrary to the ethics of clinical practice”.
  • https://www.theguardian.com/society/2017/oct/05/entombed-man-noel-conway-loses-high-court-fight-end-life

    UK: Noel Conway Case for legal Assisted Suicide at the High Court on 17 July 2017 

    Attempts by Dignity in Dying to achieve a change in the law continue. This is despite the overwhelming defeat of the Maris Bill in 2015 by 330 – 118 votes and numerous preceding failed Bill attempts to change the law. This latest DID attempt, supports Mr Noel Conway, in yet another try for a change in the law.

    Please see an analysis of this case from the Care not Killing Alliance here:

     Nikki Kenward of ‘Distant Voices’ demonstrated outside the High Court (17 July 2017) during Noel Conway’s legal bid for assisted suicide. See Nikki talking to the BBC that day:

    http://www.christianconcern.com/media/nikki-kenward-explains-why-noel-conways-legal-bid-for-assisted-suicide-must-be-rej

     September 2017: US Congress ponders assisted suicide (Acknowledgements to BioEdge)

  • A resolution condemning Assisted Suicide has been introduced to the US House of Representatives. See the link: https://www.bioedge.org/bioethics/us-congress-ponders-assisted-suicide/12453
  • Europe – Germany: Nurse may have killed at least 90 in German Nursing Homes

                                                       EuroNews  

ROYAL COLLEGE OF NURSING : ‘Raising Concerns’:

Nursing staff should feel comfortable raising concerns, but speaking out is not always easy and often takes courage.  Now a new RCN publication: ‘Raising Concerns’ supports you wherever you work and whether you act as an individual or as part of a group. Alongside a step- by- step guide, the publication looks at your rights and responsibilities; the support and response you should expect: and the differences between sharing concerns and whistle blowing. See the following link:  http://www.rcn.org.uk/publications

Care Quality Commission (CQC ): Whistleblowing: Guidance: See the following link:

http://www.cqc.org.uk/sites/default/files/20160108_Whistleblowing_quick_guide_final_update.pdf

Public Concern at Work  Charity– See the link to this UK Charity: http://www.pcaw.co.uk/

  • USA – September 2017: Are ‘brain dead. patients really dead?

  • A provocative new journal article challenges conventional accounts of human death.

  • A new article in the Journal of Medical Ethics challenges conventional accounts of human death, and calls for a “new consensus” on the ethics of vital organ transplantation. (Acknowledgements to BioEdge)

    Bioethicists Michael Nair-Collins, of Florida State University College, and Frank Miller, of Weill Cornell Medical College, assert that patients who are brain dead may nevertheless be said to have retained the integrated functioning characteristic of human life. This is the case even when the patient is supposedly “dependent” on a ventilator.

    The authors observe that that mechanical interventions (such as a ventilator) do not in and of themselves allow for the functioning of the lungs and heart — other natural bodily operations play and equally important causal role:

  • “The ventilator does not cause the heart to beat. The ventilator does not cause gas exchange. The ventilator does not trigger the actions of the other organs. And the ventilator certainly does not cause the coordination of activity between the different organs. It blows air in and out; the living organism does all the rest.”
  • The corollary to this is that the ethical justification for organ procurement from brain dead patients is undercut. “The science underlying the claim that the ‘brain dead’ are biologically dead organisms is weak and fundamentally flawed. Since the accepted ethical rationale for vital organ procurement from ‘brain dead’ patients relies on the validity of the neurological standard for determining death, the accepted ethical rationale is undermined as well.”The authors suggest that “a new consensus” must be reached on the ethics of vital organ transplantation — “one which is not premised on demonstrably false claims about the vital status of biologically living patients”.The provocative paper echoes claims made elsewhere about the invalidity of current justifications of brain death. It will be interesting to see how the bioethics community reacts to the growing clamour against conventional accounts of organismal death.
  • UK: 29 July 2017, Baby Charlie Gard dies

  • Letter to the Telegraph,  17 July 2017, from Ann Farmer:  

    Dear Sir,

     Astonishingly, the state-appointed lawyer defending little Charlie Gard’s best interests is chairman of Compassion in Dying, a sister organisation of Dignity in Dying whose aims it shares, denies a conflict of interests in representing a child whose right to be treated is being decided (Anger at choice of Charlie’s lawyer,Telegraph, July 17, 2017).
    Dignity in Dying used to be the Voluntary Euthanasia Society, formerly the Voluntary Euthanasia Legalisation Society, which in the 1930s saw euthanasia as a weapon against overpopulation and called for it to be applied to patients with diseases like tuberculosis; if they had succeeded, no cures would have been found.
    Dignity in Dying say they want to legalise the killing of people with severe problems, but by now it is abundantly clear that legalisation, even with a very narrow remit and hedged about with safeguards, establishes the precedent that for the sick and disabled and indeed anyone who is “tired of life” (as in Holland), death is in their best interests. No treatment is guaranteed to work, and if we insist on cast iron proof that it will, we may as well give up on medicine and just kill people. It’s certainly cheaper.
    Yours faithfully,
    Ann Farmer
  •  CANADA : Euthanasia provision ‘medical fees’

  • Canadian euthanasia doctors are pressuring the provincial governments to pay them more money for euthanasia. Supposedly, some euthanasia doctors have stopped killing people based on money.

     

    An article by Kelly Grant published in the Globe and Mail, appears to pressure governments to pay more for euthanasia. The article insinuates that access to euthanasia has been impeded by the money doctors make to do lethal injections:Dr. Pewarchuk, an internal medicine specialist in Victoria who has presided over 20 assisted deaths, took his name off the list of willing physicians last month after the body that sets doctors’ pay in British Columbia approved new fees that he and some of his fellow providers say are so low they could chase away even the most committed physician supporters of assisted dying.Maclean’s magazine published an article by Catherine McIntyre stating that physicians in the Netherlands are paid more money to kill:In the Netherlands, for example, where physician-assisted dying has been legal since 2002, providers are paid a flat rate of about 1,500 euros. That’s $2,200 Canadian dollars and at least five times more than what MAID providers can earn in Canada. On top of that, Dutch physicians are given a paid day off after assisting a death to take care of themselves emotionally(Correction: Professor Theo Boer sent a message to the Euthanasia Prevention Coalition’s Executive Director, Alex Schadenberg, stating that Maclean’s magazine was wrong. According to Professor Boer, doctors in the Netherlands receive 227 euro per euthanasia).

    More from Canada: ‘The Slippery slope in action’

  • http://Doctor Urges Mother to Euthanize Her Disabled Daughter Instead of Caring for Her

    (acknowledgement to Lifenews)

    See the video link: http://alexschadenberg.blogspot.co.uk/2017/07/mother-upset-after-doctor-offers.html

    (Acknowledgement to Euthanasia Prevention Coalition)

  • In other news: Scotland:

    A Scottish Catholic bishop wrote a passionate letter to his fellow Catholics in May 2017, urging them to speak out against the growing threats to human life. Bishop Stephen Robson of Dunkeld, Scotland wrote the letter for Scotland’s Day for Life on May 31, the Scottish Catholic Observer reports. He said:

    Vulnerable people such as the disabled, elderly and frail are increasingly in danger from pressures to introduce assisted suicide or euthanasia. Campaigners have been relentless in pursuing their aim of introducing such laws. Worryingly, there is a broad coalition and considerable political support for extending the threats to life including extending abortion to birth for any reason.”

  • The Bishop’s letter also coincides with the release of new data showing that unborn babies with disabilities are being aborted at higher rates than in the past in Scotland.

    UK: Multidisciplinary Conference: 08/05/2017. 10.30 – 16.15 hrs

    (Convened by the Pro-life Nurses Group).Venue: the Royal College of Nursing, 20 Cavendish Square, London.
    Keynote speakers: Dr Peter Saunders, Christian Medical Fellowship, Steve Fouch Head of Nursing, CMF and Paul Diamond, Standing Counsel for Christian Concern.
     This was a well-evaluated programme with top class speakers. The delegates were interested in knowing more about this fundamental aspect of nursing in line with the expectation of the Nursing and Midwifery Council.
    The dangers to the vulnerable today were explored well from  the historical, pharmacological, legal, nursing and conscience perspectives.

    The role of the nurse as patient advocate, is recognised as vital for patient well-being and safety,  particularly in a utilitarian age with cost- cutting preoccupying many care settings. Shift patterns, particularly 12 hour shifts, were discussed, and are known from research to be a source of nurse stress and can impact greatly on care continuity but can, and should, be re examined for their contribution to both nurse and patient best interests.

  • The Mental Capacity Act and the former Liverpool Care Pathway were revisited. Concerns were raised that the former inappropriate LCP practices are continuing in some areas. Discussion was generated about the need for automatic use of syringe drivers in Palliative Care. Though a useful means of giving drugs, this route is not always to be considered inevitable where inappropriate/not required. The defence of ‘merely obeying orders’ was emphasised  from an historical perspective – as there is no defence in law, for ‘merely following orders’ when patients are harmed (Germany,  Nuremberg World War II trials).
  • The toll,  both physical and psychological,  on the nurse, in attempting to maintain the role of patient advocate can be significant. Nurses need full support in managing this inherent responsibility with help from the profession, the managers and each other. The importance of Clinical Supervision cannot be underestimated.
  • The Nurse’s Code of Conduct is a good means of ethical and legal protection for both the patient and the nurse. There was good interaction with personal experiences being shared which included those from the nurses, a former patient, a bereaved relative (LCP experience) and a hospital visitor.
  • Simple comfort measures and extra time given by nurses, particularly at the end of life, were discussed. These do not always require expense and can relieve the possible feelings of isolation or distress, particularly when patients are placed in single rooms.

    UK February 2017. Hospital launches a probe after a stroke patient who suffered a fit in his care home is ‘put on a death pathway’

  • Walter Prescott, 62,  was admitted to hospital in Bury after suffering a fit

    His family claim he was put on a ‘end-of-life’ regime when he was discharged

    Police are probing the death of Mr Prescott’s mother in similar circumstances

  • Professor Patrick Pullicino, the neurologist who helped expose the LCP in 2012, said there were still big concerns over NHS palliative care. He called for new, fully evidence-based guidelines. Read more: http://www.dailymail.co.uk/news/article-4216162/Hospital-launches-probe-stroke-victim.html#ixzz4Yf9mw12X

     USA – Conscientious Objection

  • New England Journal of Medicine, April 6, 2017: University of Pennsylvania bioethicists, Ronit Y. Stahl and Ezekiel J. Emanuel, have written a controversial article exploring Conscientious Objection laws which give health care professionals the legal right to refuse, on the basis of personal beliefs, to perform certain procedures or care for particular patients. The authors argue that professional societies should declare conscientious objection unethical and remove conscience clauses from their codes of ethics. This opinion has caused strong reaction among conservative bioethicists. According to the authors, objection to providing patient interventions…that the profession deems to be effective, ethical, and standard treatments…is unjustifiable. Stahl and Emanuel argue that doctors, in entering the medical profession, agree to abide by the ethical and professional standards of the profession: By entering a health care profession, the person assumes a professional obligation to place the well-being and rights of patients at the center of professional practice.
    These authors suggest that doctors who object to standard practice should choose between the following two options: select an area of medicine, such as radiology, that will not put conscientious health care objectors in situations that conflict with their personal morality or, if there is no such area, leave the profession
    We hope doctors and nurses will resist with all their might, together, as a strong body, this insidious, creeping culture which is as worrying as it is chilling. Belief in the right to exercise conscientious objection reflects the belief in universal human rights, the importance of recognizing conscience as fundamental to civilisation  and ultimately the rights of vulnerable people.
    Assisted Suicide: read an American nurse’s opinion via the link: https://nancyvalko.com/2017/01/04/the-slippery-slope-tactics-in-the-assisted-suicide-movement/

    Oregon Bill Would Allow Starving Mentally Ill Patients to Death: http://www.lifenews.com/2017/02/06/oregon-bill-would-allow-starving-mentally-ill-patients-to-death/

  • Euthanasia Debate- fears of ill patient : http://alexschadenberg.blogspot.co.uk/2017/01/im-terminally-ill-and-euthanasia-debate.html

    Europe:

    Catholic hospitals in Belgium which provide a substantial portion of psychiatric beds will permit euthanasia for non-terminally-ill patients. It is an unprecedented reversal of their stand on end-of-life care.  Supporters of euthanasia, see this development as individual self-determination, which trumps long held  Judeo- Christian prohibition.  Such a development can only worry those who oppose euthanasia. Fifteen years after Belgium legalised euthanasia, most hospitals now provide  this form of ‘care’.  The overthrow of barriers which are an irresistible goal for the proponents of the culture of death has been achieved at the cost of  true medicine and patient abuse. Many patients for euthanasia will be non- consenting as seen in those countries/states where euthanasia has been legalised.

    The religious founders of these care facilities are opposed to this decision, taken by lay people now involved in the day to day running of the hospitals. 

  • Switzerland: February 2017 : Completely ‘locked in’ patients can communicate: http://www.bbc.co.uk/news/health-38761461

  • Holland

    A Dutch doctor who held down a patient and euthanised her against her will did not break the law, a panel has ruled. A committee in the Netherlands concluded that the doctor had “acted in good faith”, even though the patient, who had dementia, struggled when the doctor tried to insert the intravenous drip. The committee decided the case should be brought to court to determine whether other doctors who euthanise dementia patients will be prosecuted. Andrea Williams, Chief Executive of Christian Concern, described the case as “a tragedy”.

    “This story is an example of the risks that the Netherlands liberal euthanasia laws are placing on the elderly, the sick and the vulnerable.

    “It should never be for a doctor to decide on a patient’s  behalf whether that patient wishes to live or die. 

    “Despite this tragedy, this doctor has not been charged. This sends the wrong message to Dutch society and indicates that others may carry out similar actions in future without facing prosecution.

    “The Netherlands is increasingly embracing a culture of death, when instead it should be promoting life and doing more to protect it. It is vital that we firmly resist any such policies being implemented in the UK.

    Australia:Leading Australian journalist decries push for euthanasia

    Opinion: UK  http://If it’s right to oppose the killing of human beings at the beginning of life, why do so many

          evangelicals say it‘s okay near the end of life?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

End of Life and Palliative Care, Nursing Times On line Comment

 Comment on: How EastEnders injected realism into Peggy Mitchell’s death

TERESA LYNCH’S COMMENT 19 MAY, 2016 4:29 PM

 When will the BBC show at least a degree of balance to its programming? Peggy’s demise in

EastEnders is just the latest in the BBC’s apparent dedication to showing suicide as the best option

at the end of life. Its recent pro assisted suicide programme about Dignitas revealed a clear need

 for another view to be portrayed. Many patients, whose time at the end of life is considered

 precious by themselves and their families, and love life, can be so well managed without the need

 for assisted suicide. The BBC’s negative portrayals of end of life experience need to be balanced by

a more positive experience of which there are many. The BBC in portraying repeatedly this

creeping, defeatist ‘control’ of all aspects of life as entitlement, should ponder the staggering

 statistics on suicide for men under 45 in the UK. As a nurse opposed to euthanasia, it is well known

 that once assisted suicide is legalised, it heralds in euthanasia as the experiences in Holland and

Belgium testify. Time will tell whether the BBC will decide on a more balanced approach to this

serious subject .

Comment on: ‘Nursing has for too long been outside assisted dying debate’

TERESA LYNCH’S COMMENT 26 JULY, 2014 7:37 AM

Medicine and nursing in the 21st Century ever seeks to increase the percentage of patients achieving a pain-free existence in the terminal phase of illness. Patients with end stage disease are a constant challenge to the vocational skills of their carers. In my experience, patients look to their carers to affirm their lives, not offer them death as a defeatist, cheap and easy option.

No one of any age or degree of illness is granted a pain-free existence. To suffer is part of the human condition. We see practical love operating frequently in times of natural disaster, to make bearable the suffering of those having experienced loss, natural disasters, torture, persecution, injustice,or bereavement, in other words, in all forms of suffering, whether mental or physical.  What makes suffering bearable is the constant, invaluable support by family and friends, and of course their carers in their loving concern,support, and practical care for pain, wounds and misery.

No one should be unaware that rather than pain, ‘fear of being a burden’ underlies many people’s request for assisted dying, where it is legally-sanctioned. What an incredibly sad premise for this proposed law.  The worst pain then, experienced by dying people is the fear of abandonment by their carers. Do we now compound this fear by offering the abolishment of the burden of suffering together with patients’ lives in the increasing numbers as seen in other European countries?

Nurses will be the ones expected to fulfill the requirements of this Bill. I know many will refuse the implementation of such a dangerous and unnecessary law. Such a stand will no doubt lead to their persecution for a lack of so called ‘compassion’.

Comment on: End-of-life care pathway ‘used to cut costs’

TERESA LYNCH’S COMMENT 16 JULY, 2012 9:10 PM

The dangers of this Pathway spell out the overdue need for rational, evidence-based discussion among health professionals about its relevance to optimum patient care.

The Government’s End of Life Care Strategy suggests that the definition of the beginning of end of life care is variable according to individual person and professional perspectives. For some, the start may be at the time of diagnosis of a condition which usually carries a poor prognosis. For others, it will be at a point when there is deterioration in a chronic illness and it becomes apparent that the likely prognosis is measured in months or possibly a year or two. Alternatively, it could be an elderly person who is becoming increasingly frail (End of Life Care Strategy 2008).

Patients with increasing frailty or with a stable chronic illness, do not automatically become in the ‘dying’ phase, nor should they be considered eligible for a care pathway for dying patients.

Misuse of terminal sedation involves the sedating of patients who are not terminally agitated, delusional or psychotic and have no clinical need to be sedated. Families have reported that patients often were eating, drinking, talking, even walking immediately before being sedated and all of a sudden became comatose. The issue of ‘unfinished business’ is important to be addressed, and is a very relevant concept to many patients reaching the end of life and their families. The aim of those who care for dying patients, is not to speed them towards death. They are very well-placed as companions for the dying patient. Professionals hone their skills to acknowledge sensitively with patients, the inevitability of death. This allows professionals and patients to concentrate on improving the quality of their lives, to put their affairs in order and, wherever possible, to say goodbye before it is too late.

Comment on: ‘Many nurses would not wish to administer the drugs to end an intolerable life’

TERESA LYNCH’S COMMENT 28 MARCH, 2012 10:06 PM

There are two aspects here that give grave cause for concern in the headline and throughout this opinion piece.  Firstly, giving drugs with the intention of ending life (that is, killing someone) is something that no nurse should do under any circumstances. Yet the headline suggests that some nurses might wish to do so, contrary to the criminal law and medical ethics which is a very serious matter.

The second point of concern is the unquestioning use of the term “an intolerable life”. “Intolerable life” is one of the current buzz-words of the euthanasia lobby – it’s an idea that is used to attack the right to life of the weakest and most vulnerable people (who are often, but not always, those whose suffering is most intense). The idea that some lives are “intolerable” is used in discourse, in legal argument to justify making exceptions to the right to life. Just as terms such as “quality of life” or being a ‘burden on society’ have been used to justify euthanasia in the past, the current effort is focussed on the notion of ‘intolerability’. The reason the assisted suicide/euthanasia lobby keep changing tack is that people realise that the main victims of any such weakening of the law will be the elderly, disabled, demented or dependent.

It betrays a deep-rooted discriminatory attitude when people respond to an “intolerable life”, by asking about how to end the life, rather than how to make it more tolerable.

The point that “there will always be another determined individual ready to fight all the way to the highest court” is interesting. Those people who take their cases to the courts are at the prompting of euthanasia campaigners, who want them to kill themselves (or be killed) rather than make a recovery. The cases are run by pro-euthanasia lawyers and (in the media) by the euthanasia society’s publicity machine. Of course individuals will keep pursuing this approach when the media and the legal authorities are happy to encourage them. The pro-death lobby has not suddenly emerged in the past few years: the anti-life humanist/atheist promotion of euthanasia has been around for many decades – or centuries.

Comment on: ‘Assisted dying would provide dignity in death’

TERESA LYNCH’S COMMENT 23 JANUARY, 2012 10:29 PM

Sedating patients into unconsciousness and also deliberately depriving them of food and water will end life for that patient. “The World Health Organization has demonstrated that access to pain-relieving drugs, along with a simple educational program, can achieve relief in the vast majority of patients. Specialists in various parts of the world estimate these basic approaches can control 85 to 98 percent of cases. The remaining cases require more careful attention and the use of multiple drugs and therapies to achieve complete relief.”[1]  These words were written in 1995. Professionals aim to move forward in the challenges of medicine and healthcare, including the problem of pain management. Many benefits for patients have been achieved over time by meeting such challenges which appeared insurmountable at the time. [1] Dr. John Scott, “FEAR AND FALSE PROMISES: The Challenge of Pain in the Terminally Ill” in EUTHANASIA AND ASSISTED SUICIDE: The Current Debate , ed. Ian Gentles (Toronto: Stoddart Books, 1995), p. 96.

What do we really mean by ˜indignity and loss of control’? Baroness Young will be aware that Lord Falconer’s Commission on Assisted Suicide was supported by advocates of assisted suicide. Those who accept uncritically its findings and recommendations overlook this fundamental flaw of bias. To endorse such a Commission’s findings does a disservice to those patients in the Netherlands who, despite so called safeguards within the law, have been killed without their wish. Such a process does not provide dignity in death or more control  as Baroness Young suggests would be derived from a change in UK law. Furthermore, these patients did not have to be assisted in their dying by strangers in a foreign country, but were killed by their own carers, in their own country and against their will. Therefore, I find it incomprehensible that Baroness Young asserts, that the Commission found no evidence to suggest that changing the law on assisted dying would have a negative impact on end-of-life care.  In light of these points, proponents of assisted suicide do not encourage vulnerable groups to feel anything other than at great risk from a change in current UK law. It is now well- established that disabled people are extremely concerned about a possible change in the law. Despite it being a long-held expectation that carers are to be trusted, vulnerable groups fear that in the event of a change in the law on assisted suicide, safeguards, in no time, may be considered as barriers to be overcome, particularly in financially challenging times.